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Acad Med. 2018 Mar;93(3S Competency-Based, Time-Variable Education in the Health Professions):S27-S31. doi: 10.1097/ACM.0000000000002067.

What Regulatory Requirements and Existing Structures Must Change If Competency-Based, Time-Variable Training Is Introduced Into the Continuum of Medical Education in the United States?

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J.R. Kogan is professor of medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. A.J. Whelan is chief medical education officer, Association of American Medical Colleges, Washington, DC. L.D. Gruppen is professor, Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan. L.A. Lingard is professor, Department of Medicine, and director, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. P.W. Teunissen is professor, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands, and maternal fetal medicine specialist, VU University Medical Center, Amsterdam, the Netherlands. O. ten Cate is professor of medical education, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands.


As competency-based medical education is adopted across the training continuum, discussions regarding time-variable medical education have gained momentum, raising important issues that challenge the current regulatory environment and infrastructure of both undergraduate and graduate medical education in the United States. Implementing time-variable medical training will require recognizing, revising, and potentially reworking the multiple existing structures and regulations both internal and external to medical education that are not currently aligned with this type of system. In this article, the authors explore the impact of university financial structures, hospital infrastructures, national accrediting body standards and regulations, licensure and certification requirements, government funding, and clinical workforce models in the United States that are all intimately tied to discussions about flexible training times in undergraduate and graduate medical education. They also explore the implications of time-variable training to learners' transitions between medical school and residency, residency and fellowship, and ultimately graduate training and independent practice. Recommendations to realign existing structures to support and enhance competency-based, time-variable training across the continuum and suggestions for additional experimentation/demonstration projects to explore new training models are provided.

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